When less is more: The perception of psychotherapy techniques as a function of patient personality disorder

Ilana Lipsitz-Odess, Hadar Fisher, Ori Kartaginer, Liat Leibovich, Sigal Zilcha-Mano

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Psychopathology research suggests that individuals with higher levels of personality disorder (PD) traits, especially those with a comorbid major depressive disorder (MDD), tend to be highly aroused in interpersonal contexts, manifested by an intensified perception of interpersonal interactions. Little is known about the way this tendency manifests in the process of psychotherapy. The current study explored the patient's perception of techniques in psychotherapy among patients with higher vs. lower levels of PD, as well as the patient–therapist agreement on techniques used. Design: The study used an integration of qualitative and quantitative methodology on data from a randomized controlled trial (RCT) for the treatment of depression. Method: Sixty-nine patients with MDD participated in the study and were evaluated for PD symptoms prior to treatment. A set of multilevel analyses were conducted to assess the association between PD and perception of techniques, as well as a zoom-in exploration within a case study. Results: Patients with higher levels of PD reported more techniques implemented by the therapist than patients with lower levels. In addition, the agreement between patient and therapist on techniques was lower, such that patients with PDs reported more techniques than their therapist. The case study supported these findings and illustrates the potential for patients with PDs to perceive a greater use of techniques as a sign of therapist investment. Conclusion: Consistent with psychopathology research, the findings suggest that patients with PDs tend to experience techniques as more intense than the therapist, in comparison with patients without PD. Practitioner points: There are indications that patients with higher levels of personality disorder traits will tend to experience the techniques in psychotherapy in a more intense manner than patients with lower level personality disorder traits. It is likely that patients with higher levels of personality disorder traits will experience their therapists as more active than therapists think they are. Therapists of patients with higher levels of personality disorders should be sensitive of each of their patients’ experiences. As the case study demonstrated at least in some cases patients with higher levels of personality disorder may experience the techniques in an intense manner as a sign of therapist investment, however, other patients may experience this differently. Therefore, it is crucial for the therapist to be aware of how the patient experienced the encounter – investment or intrusiveness.

Original languageEnglish
Pages (from-to)929-951
Number of pages23
JournalPsychology and Psychotherapy: Theory, Research and Practice
Issue number4
StatePublished - Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Israeli Science Foundation (Grant no. 186/15).

Publisher Copyright:
© 2021 British Psychological Society


  • bias
  • perception
  • personality disorder
  • psychotherapy
  • techniques


Dive into the research topics of 'When less is more: The perception of psychotherapy techniques as a function of patient personality disorder'. Together they form a unique fingerprint.

Cite this